a.
b.
EMANCIPATION OF MINOR INCOME
AND EXPENSE DECLARATION
Form Adopted for Mandatory Use
Judicial Council of California
EM-115 [Rev. September 1, 2018]
Family Code, § 7000, et seq.
www.courts.ca.gov
Page 1 of 2
I am attending school (name of school and grade):
1. My name and address are:
My telephone number is:
I have been living at this address since:
I live there with (name and relationship of all persons, including children):
2. My date of birth is:
3.
I am not attending school. The highest year of education I have completed is:
4.
a.
b.
5.
I am employed. My place of employment is (name and address):
I started work there on (date):
I am not employed at the present time. I last worked from (starting month and year):
to (ending month and year):
My gross monthly earnings were: $
a.
b.
6.
c.
d.
I am not receiving welfare or AFDC and I do not intend to apply for welfare or AFDC.
I am receiving welfare or AFDC. Monthly amount received: $
I have applied for welfare or AFDC.
I intend to apply for welfare or AFDC.
My occupation is:
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
Petitioner, a minor
IN THE MATTER OF (name):
EMANCIPATION OF MINOR INCOME AND
EXPENSE DECLARATION
FOR COURT USE ONLY
CASE NUMBER:
EM-115
